Provider Demographics
NPI:1821871385
Name:RENFRO, KAITLIN (FNP-C)
Entity Type:Individual
Prefix:
First Name:KAITLIN
Middle Name:
Last Name:RENFRO
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 BURKE ST
Mailing Address - Street 2:
Mailing Address - City:CALHOUN CITY
Mailing Address - State:MS
Mailing Address - Zip Code:38916-9675
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:120 BURKE ST
Practice Address - Street 2:
Practice Address - City:CALHOUN CITY
Practice Address - State:MS
Practice Address - Zip Code:38916-9675
Practice Address - Country:US
Practice Address - Phone:662-628-5116
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-17
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS906175363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner